Dear Home Dialysis Central Readers:
Dori has asked if I would be happy to trial a ‘question and answer’ spot on HDC for issues relating to haemodialysis. As I think there is a need for this, I am prepared to give it my best shot.
Though I will do my best to help you, please also understand that I …
• direct a very active renal service with full dialysis & transplant activities
• see ~20 general nephrology, dialysis and transplant patients every day of the week
• teach undergraduate and graduate students
• provide consultant cover for renal inpatients of a big public hospital
• provide sole on-call cover 2 weeks in every 8
• provide senior physician services to a busy transplant unit
• advise on many state and national government and industry committees
• manage and advise patients from around the world through my website
• run a research program
• publish in and review for many journals
• travel to and speak at multiple national and international meetings
• worship an Australian Rules football club - the Geelong Cats
• and … have a wife, children, grandchildren and friends who I love and value above all and for whom I must somehow find equal time
Within these constraints, I will try to answer questions relating to the ‘how’ and ‘why’ of dialysis and the impact of dialysis on ‘the workings’ of the body.
There are significant (sometimes huge) differences between the care provided in the US and in other countries. In my view, the US frequently does not often come out ahead in these different practices. They are differences I cannot influence. I can only answer your questions from my own experience and knowledge – most of which has been gained outside the US.
I cannot comment - indeed, will not comment - on any concerns about the management prescribed or advised by other professionals. That is not the purpose of this site.
You must remember that each patient (each ‘you’) is different and that sound medical advice requires an intimate understanding of ‘you’, the individual. Further, such knowledge cannot be obtained through an internet-based public network. I cannot - and will not - enter into private advice. My comments will remain general.
Some tend to ask recurrent, frequent questions. Please … do not try to monopolize the site with overly frequent questions or try to engage me in recurring debate on a topic. This will lessen my time availability to answer others. If this problem occurs, I reserve the right to terminate my responses to that questioner or to that debate.
This Q&A facility is not being trialed for the benefit of any one individual. Remember, it is here for all dialysis patients – not just ‘you’. If this problem arises, I reserve the right to ask for intervention from the HDC moderator.
Further, I do not wish to deal with, nor will I answer, questions that…
• Enter into discussion about or are specific to the structure or politics of the American Health System. I am an Australian. I work in a system very different to the US system. I believe in the Australian way. I also know far too little about the US program – or am too biased towards our own – to make valuable comment regarding the systems of other nations.
• Argue how dialysis patients and programs may be ‘advantaged’ or ‘disadvantaged’ within the US system.
• Venture into either legal or adversarial domains.
If your questions focus on the practical, clinical and medical aspects of dialysis, I will do my best to answer them. In that respect, I trust you will benefit from this pilot program. Some questions, I cannot answer.
As an example: many home patients in the US use a machine called the NxStage. NxStage is not available in Australia and though I have passing knowledge of it, that knowledge is not sufficient for me to make sensible or intelligent comment about it. If such questions come to me, I will have to defer them (regrettably) to others to answer.
Finally, none of my comments or responses can ever replace the advice of your medical team. This is clearly set out in the ‘legal disclaimer’ on this site. Those advisors – your ‘proper’ doctor and nurses – remain, and must remain, your primary and final point(s) of reference.
If we all respect these boundaries, I believe this trial (6 months) can be a positive effort for us all. Ignore them, and this endeavor will neither work nor survive.
Prof. John Agar OAM, MB.BS, FRACP, FRCP (London)
Director: Renal Services
Geelong Hospital, Barwon Health
Geelong, Victoria, 3220, Australia